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How to Cut Through the Noise of the Healthcare Internet of Things

"You’re not just asking patients to change their behaviors" when it comes to the healthcare Internet of Things. "You’re asking physicians to do it, too.”

February 10, 2016 - Healthcare providers are busy people. Between high patient loads and the demands of EHR documentation, the reporting requirements, the internal meetings, and the minutes wasted waiting for test results or other communications from the care team, there is often precious little time to get a cup of coffee, let alone sit down to rethink their workflow procedures.

Sometimes they’re so busy that being asked to take an hour out of their hectic schedules to try out new time-saving technologies seems like a particularly cruel joke.

An endless cavalcade of pitches and promotions from start-ups offering the latest and greatest in patient engagement tools and big data analytics products often goes ignored as clinicians hustle to clear waiting rooms, finish up paperwork, and maybe – just maybe – even leave the office on time.

While developers are cashing in on growing consumer interest in wearable devices, connected home monitors, and fitness trackers, the Internet of Things hasn’t really demonstrated its ability to bring value into the clinical environment.

Patient-generated health data is largely ignored by physicians who are frustrated by the idea of combing through reams of irrelevant information, and EHR vendors have been so preoccupied with basic usability and interoperability concerns that IoT integration hasn’t yet become a show-stopping priority.

But change may be on its way. Instead of exclusively focusing on bringing new gadgets and gizmos to market to attract consumer dollars, Internet of Things advocates are starting to address the data integration challenges of bringing IoT tools into the provider sphere.

It isn’t an easy process, says Ben Jonash, Principal at Doblin, the design and innovation arm of Deloitte LLP. The spotlight on population health management and chronic disease management is opening up opportunities for companies looking to provide clinicians with the competencies they need to take advantage of value-based reimbursement.

Provider resistance to untested technologies, and a tendency for developers to focus on style over substance, has thus far prevented the Internet of Things from truly taking off in healthcare. However, the potential is there – if vendors and healthcare organizations decide to work together to ramp up the signal and pare away the noise.

Sustained engagement is key to driving behavior change

It all starts with big data, Jonash told HealthITAnalytics.com. The healthcare system is starting to acknowledge that non-clinical factors, such as lifestyle choices and socioeconomic barriers, are just as important as clinical approaches to patient care.

But that presents a new set of problems for clinicians inundated with information that may or may not be relevant to the decision-making at hand.

“From the payer’s perspective, they are trying to get upstream of a lot of chronic diseases, and they’re starting to think about well-care as much as sick-care,” he said. “But providers are having some problems with this, because they are having trouble dealing with this crazy, messy new world of patient-centered health data and wellness data that doesn’t synch into their systems.”

“How can providers maintain a connection to all of this? And how do they make sense of all the different start-ups and developers and product options that are banging on the door, begging to get in? At the end of the day, you’re trying to change a lot of lifestyle behaviors and integrate that into some specific disease and clinical work that you’re doing, but you have to cut through a lot of noise.”

Providers simply don’t have the time – or the financial incentive – to hunt through a pile of start-up brochures looking for the next big thing, he added.

“Two people in a garage who claim they can do something isn’t quite as compelling as someone who can demonstrate that they have real, thoughtful ways of delivering behavior change around a disease,” he said.

And even if a healthcare organization somehow stumbles upon the perfect app or cutting-edge wearable, patients need much more than a downloadable promise that their lives about to change for the better.

“I don’t think digital therapeutics is about having a shiny app that suddenly solves everything,” said Jonash. “It’s about a thoughtful integration of digital tools and behavior change mechanisms that can integrate with overall care programs. You can’t just ask patients to do this themselves and coordinate everything with their care team.”

“Consumer apps that you buy with your phone in a store aren’t going to produce the greatest impact. It’s the integration with the non-digital world that is really going to improve chronic disease management.”

Payers and providers may have the most obvious financial stake in the chronic disease management market, but other entities, such as employers, are also looking for ways to turn wellness into a competitive advantage.

The key to generating meaningful behavior change is ensuring that these efforts “complement what’s happening in the clinical space,” Jonash stressed.

“A lot of innovation is coming from non-traditional technology players that have realized there are much more elegant, lower-friction ways to get consumers and patients to engage in their health and leverage patient-generated health data to create different behavior patterns.”

Can the IoT and the EHR ever become friends?

These players have one big obstacle to overcome: the electronic health record. At the moment, few EHR products have the ability to meaningfully integrate patient-generated health data from wearables or home monitors, and even fewer can use these disparate data streams for clinical decision support or predictive analytics.

Many providers are just learning to trust the data served up to them by their EHRs. Data integrity concerns are still a major challenge for numerous organizations, and even something as simple as ensuring that a nurse is looking at the right patient’s file is so difficult that contests are offering millions of dollars for a fool-proof solution.

EHRs can do some things well, Jonash says. They generate defined, relatively standardized datasets that usually contain a limited number of elements. Patient-generated health data, on the other hand, “is this messy, undefined stack of data that doesn’t sit within the EHR system,” he explained.

“Can providers trust it? Do they? Is it good data? The number one reason why clinicians don’t like PGHD is the hassle factor. It’s too much work to determine whether they’re being sent a signal or just too much noise.”

“A primary care physician isn’t going to sit and stare at a live feed of your blood glucose monitor,” he added. “They want to see digital therapeutics incorporated into a better way to deliver medical care.”

Patient engagement products must make it easy and intuitive to extend the care continuum from the provider’s office and into the patient’s home, otherwise they are not providing value for money, Jonash said.

“The Internet of Things and all of these patient engagement tools have to augment the process of overseeing patients. Because you’re not just asking patients to change their behaviors. You’re asking physicians to do it, too.”

“Anything that adds a minute of extra work to their day is just not going to cut it – unless it’s accompanied by a different business model that allows them to get paid for their efforts.”

Making the Internet of Things work for healthcare

New business models are evolving, and they are successfully creating incentives to make patient engagement and population health management a core competency for providers of all types.

But there is a trick to picking the right IoT technologies to complement a chronic disease management or care coordination program.

“I often talk to clients about being device agnostic,” said Jonash. “You don’t want to be in the business of picking winners and picking this company versus that company when it comes to sensors.”

“You want to be in the business of setting the guardrails around what a great patient experience would look like, and developing process guidelines that don’t overwhelm or overburden your care team.”

Be discerning when choosing a digital therapeutics vendor to work with, he added, but don’t be inflexible. Not every start-up with a great idea has the capital to run a clinical trial to prove their technology really works – and some simply lack the good fortune to have come across a provider willing to take a chance on integrating a new solution into their care management strategies.

“It costs a lot of time and money to address the “show me you’ve done it already” questions that providers are asking,” Jonash said. “That’s a really high bar for some of these companies to meet.”

Providers shouldn’t feel obligated to stick their necks out for every Kickstarter project with an alluring sales pitch, but being proactive instead of obstructive can reap rewards.

“There’s an opportunity for providers to create venues that make it easier for these new players to demonstrate their capabilities,” Jonash asserted.

“Be the easiest provider to work with, and you’ll find that a lot of really innovative people want to talk to you, and you can choose from the best of them. That’s a powerful place to be. But if people aren’t really sure how to work with you, you’re going to lose out on a lot of opportunities.”

Clearly define a set of realistic goals for the project, such as helping high-risk diabetics control their blood sugar or creating an incentive program for chronic heart failure patients to lose weight.

“Don’t try to solve it all at once,” Jonash advised. “Pick a few areas where you can set up a model and show that it works and that you can integrate it into your workflow. Don’t just be seduced by the newest app or most dazzling devices.”

“You want to find someone who has actually developed something that drives patient engagement. You want someone who can talk to you about actually focusing on health outcomes instead of just showing you an interesting interface.”

His advice for the developer community is similar. Pay attention to the shifting demands of the marketplace, and constantly reassess whether or not a new idea will truly deliver better care in a simple, intuitive, effective way for everyone involved in the process.

“You don’t want to keep your head down for a year, build something, and then first pick your head up and see if the market likes it,” Jonash pointed out. “You want to be taking a much more human-centered, agile approach, where you’re working with lightweight prototypes and seeing if patients and providers engage with it.”

“Create an environment where you can actually stimulate change – not just with patients, but with the provider workflow. You’re going to be setting yourself up for failure if you spend all your money building a system only to find that no doctor would ever want to use it because it doesn’t work with how they behave. Think about lightweight innovation methods that can help you prove that your product can really make a difference.”